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10D2166161 CLIA NUMBER - COMMUNITY HEALTH OF MELBOURNE BEACH LLC DBA SURFSIDE PEDIATRICS

Laboratory Demographics

CLIA Number: 10D2166161

Facility Name: COMMUNITY HEALTH OF MELBOURNE BEACH LLC DBA SURFSIDE PEDIATRICS

Facility Address:
150 5TH AVE SUITE C
INDIALANTIC, FL
ZIP 32903
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Facility Phone Number: 321 821-4882

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1245665199

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name Field Value
CLIA Number 10D2166161
LAB Type Physician Office
Facility Name COMMUNITY HEALTH OF MELBOURNE BEACH LLC DBA SURFSIDE PEDIATRICS
Street 150 5TH AVE SUITE C
City INDIALANTIC
State FL
ZIP 32903
Phone 321 821-4882
CertificateType 4
CertificateEffectiveDate 5/14/2023
CertificateExpirationDate 5/13/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024